Cytological Spectrum of Premalignant Lesions of the Cervix among Women in Yola, Nigeria

Abstract

Background: Cervical cancer remains an important public health problem, particularly in low- and middle-income countries, where access to organised cervical cancer screening is limited. Papanicolaou (Pap) smear cytology provides a relatively simple and accessible method for detecting cervical epithelial abnormalities before progression to invasive carcinoma. Aim: This study assessed the cytological spectrum and frequency of cervical epithelial abnormalities detected during an organised Pap smear screening programme in Yola, northeastern Nigeria. Materials and Methods: This study involved women who presented for an organised Pap smear screening programme at Specialist Hospital, Yola, Adamawa State, Nigeria, between 19 and 21 October 2023. Cervical specimens were collected using an Ayre spatula, prepared as conventional Pap smears, and stained manually using the Papanicolaou method. Cytological findings were reported according to the 2014 Bethesda System. The distribution of cytological diagnoses by age group was summarised using descriptive statistics. Results: A total of 181 women were successfully screened. Of these, 108 (59.6%) smears were negative for intraepithelial lesion or malignancy (NILM), 72 (39.8%) were abnormal, and one (0.6%) was unsatisfactory. Among the abnormal smears, low-grade squamous intraepithelial lesion (LSIL) was the most frequent epithelial abnormality, occurring in 27 women (14.9%), followed by atypical squamous cells of undetermined significance (ASC-US) in 12 (6.6%) and high-grade squamous intraepithelial lesion (HSIL) in four (2.2%). Atypical glandular cells and atypical squamous cells in which HSIL could not be excluded were each identified in one woman (0.6%). Severe inflammation, atrophy, and ectropion were identified in 14 (7.7%), 10 (5.5%), and three (1.7%) women, respectively. Most participants were aged 40–49 years, while LSIL and HSIL were more frequently observed in the older age groups. Conclusion: Cervical epithelial abnormalities were identified in a substantial proportion of women who attended the organised screening programme, with LSIL being the most frequently observed epithelial abnormality.